It is well to consider the risk of inducing dependence whenever a patient is started on hypnotics. Dependence, as used in this chapter, refers to an interaction of a person, a drug, and the environment resulting in habitual consumption (World Health Organization, 1969,1975).* Qualities which are often related include tolerance and physical dependence. Tolerance refers to a diminished response to a given quantity of drug on repeated use, which may lead to increasing the dosage progressively to maintain the desired effect. Physical dependence refers to the production of a characteristic group of symptoms when the administration of a drug is discontinued. (Upon withdrawal of high chronic doses of barbiturates, for instance, there can occur a symptom complex including seizures, fever, and delirium.) The relationship of tolerance and physical dependence to the compulsion habitually to consume a drug is not clear. A World Health Organization (1975) Scientific Group has emphasized that neither quality is essential to dependence, pointing out that such drugs as nalorphine and cyclazocine may produce both tolerance and physical dependence but do not induce drug-seeking behavior in animals or man. Conversely, cocaine and some stimulants do not produce physical dependence, yet may produce a strong craving.
KeywordsSleep Disturbance Withdrawal Syndrome Physical Dependence Disturbed Sleep Classical Drug Abuse
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